“Our inquiry has raised serious question marks about the competence, capability and capacity across the health system to deliver a digital transformation in Welsh healthcare.

“And yet we discovered a culture of self-censorship and denial amongst those charged with taking the agenda forward – in NHS Wales Informatics Services (NWIS) itself, as well as its partners in the health boards and the Welsh Government.”

– Committee Chair, Nick Ramsay AM (Con, Monmouth)

1. Nobody is being honest about the difficulties with NHS IT systems

From the outset, the Committee was disappointed by the lack of transparency and candour from witnesses, with a seeming reluctance amongst them to be critical on the record; the Auditor General commented that NWIS were “overly positive” when reporting its own progress.

“The Committee is concerned that this cultural problem may be masking wider and deeper problems which we did not uncover. We believe a fundamental change in behaviour from NWIS and the wider NHS Digital team is required if progress is to be made.”

The Committee was also concerned about the slow pace of delivery of new IT systems and that seems to be the case for absolutely everyone involved. NHS bodies were said to be frustrated by the slow roll-out, while NWIS were frustrated by the lack of direction given to them by the NHS as a whole.

Many parts of the NHS are, even now, still reliant on paper records when the report says electronic records often “lead to better patient care and outcomes”.

The Committee demanded updates every 6 months from the Welsh Government on progress and wanted assurances from the government that NHS IT systems are resilient after a number of reported system outages (which I turn to later).

2. Spending on IT systems has fallen

The NHS in Wales is said to spend as little as 2% of its budget on IT, and within that only 10% is dedicated to innovation and the development of new systems. Spending is also said to be falling in general with NWIS and individual health board IT budgets being cut.

To achieve the vision for IT systems set out by the NHS and NWIS, it was estimated an additional £484million would be required on top of current spending. The Welsh Government have committed to carry out a full cost-benefit analysis, though there was no commitment to extra funding.

The Committee believes that without extra funding, the rollout of electronic records “in a reasonable timeframe” will be impossible. IT systems needed to be re-framed as an investment which can save the NHS money through reduced mistakes.

3. Data outages may have put patients at risk

There’ve been 21 outages of NHS IT systems between January and July 2018, with Velindre NHS Trust (which focuses on cancer treatment) saying it had a negative impact on patient care and staff morale. Another incident, lasting 3 days, was reported by the Cardiff & Vale health board in August 2018.

The Welsh Government and NHS didn’t think this impacted patient safety, even though timeliness of treatment was vital to cancer patients; however, they were unable to properly explain why they believed this was the case.

NWIS said:

“There was an increased risk to patients with GP consultations, creating anxiety for clinicians and patients as a result of the inability to view all patient records, as well as an increase in the delays in patient flows within Outpatients, Emergency Department, Endoscopy, and Theatres. Some patients required repeat diagnostics as a result of the inability to process some pathology samples.”

The outages have been partly blamed on Welsh NHS data centres being more than seven years old. Also, Microsoft stopped technical support to parts of the cancer system (CaNISC) in 2014, resulting in a serious cybersecurity risk.

While the Welsh Government has provided £1.3million for upgrades, cloud storage is becoming more commonplace and the Committee felt spending money on the current infrastructure was “throwing good money after bad”.